Neurodivergence

On this page you will find clinician information, links, resources and relevant prescribing guidance for neurodivergent people

This page contains clinician information, links, resources and relevant prescribing guidance for neurodivergent peoplePlease expand the topics below for more information.

This is a new page which we will continue to build, if you have any feedback, please email: somicb.medicinesmanagementteam@nhs.net

Current News

Supply Problems with ADHD Medicines- May 2024

The supply of most methylphenidate medications is currently improved. See the Medicines Supply tool for information for current shortages.

The supply of lisdexamfetamine has improved. Lisdexamfetamine 40mg and 60mg capsules are expected to return to stock by August 2024. Somerset Foundation Trust will be initiating new patients on Elvanse® and Elvanse® Adult capsules usually utilising the 30mg, 50mg & 70mg titration schedule.

Use the Specialist Pharmacy Service Supply Tool. Log in for full details.

Please continue to access Specialist Pharmacy Service - Prescribing available medicines to treat ADHD - May 2024 update for latest supply information.

January 2024-Somerset ADHD services will restart requests to share care in line with the Somerset shared care protocol for stable patients.

Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurological disorder that impacts the parts of the brain that help people plan, focus on, and execute tasks. ADHD symptoms vary by sub-type — inattentive, hyperactive, or combined — and are often more difficult to diagnose in girls. Both adults and children can be diagnosed, symptoms are present from childhood. ADHD is not a behaviour disorder or mental illness and is a disability protected under the Equality Act 2010. 

Learning Disabilities

People with learning disabilities (LD) have poorer physical and mental health than other people and die younger. Many of these deaths are avoidable and not inevitable. Annual Health Checks can identify undetected health conditions early, ensure the appropriateness of ongoing treatments and establish trust and continuity of care.

For information on STOMP (Stopping Over Medication of People with a Learning Disability, Autism or Both) see below

Autism

Autism is a spectrum condition and affects people in different ways. Autistic people may have other neurodivergent co-morbidities or autism may be a standalone diagnosis. Autistic people can have difficulty accessing timely healthcare due to diagnostic overshadowing, lack of understanding from healthcare professionals about normal autistic behaviours and expecting autistic people to communicate in a neurotypical fashion, for example contributing agitation to their diagnosis rather than pain or constipation, or asking for pain on a scale of 1-10. Autistic people are more likely to be overprescribed psychotropic medications and other high risk medications which may be inappropriate. Resources are shared below on supporting autistic people with their medical conditions including non-pharmacological options and how to reduce inappropriate over-prescribing.

For information on STOMP (Stopping Over Medication of People with a Learning Disability, Autism or Both) see below

Oliver McGowan

The Oliver McGowan Mandatory Training on Learning Disability and Autism is named after Oliver McGowan, whose tragic death shone a light on the need for health and social care staff to have better training. The training aims to save lives by ensuring the health and social care workforce have the right skills and knowledge to provide safe, compassionate and informed care to autistic people and people with a learning disability. 

Stopping Over Medication of People with a Learning Disability, Autism or Both (STOMP)

Psychotropic medicines are more likely to be inappropriately prescribed to people with a learning disability or autism

STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organisations which are helping to stop the over use of these medicines.  STOMP is about helping people to stay well and have a good quality of life.

NHS England – Stopping over medication of people with a learning disability, autism or both (STOMP)

"Over-medication, and then lack of review, is a historic problem, but one that nobody knew the true scale of until recently. It is estimated that on an average day in England, between 30,000 and 35,000 people with a learning disability are being prescribed powerful drugs, with serious potential side effects, without clinical justification and for too long. This is often despite evidence-based alternative interventions being available. This inequality in care is unacceptable, and it is incumbent on clinicians and every other professional involved in an individual’s care to ensure they are acting in their patient’s best interest at all times."

Royal College of General Practitioners

See our Scorecard 23/24 page for information on our scorecard indicator focusing on reducing the number of patients with learning difficulties and/or dementia that are prescribed antipsychotic medication but have no diagnosis of psychosis.

See also our Deprescribing page.

Mental wellbeing and emotional distress

It is estimated that 40% of people with a learning disability experience mental health problems (Mental health problems in people with learning disabilities: prevention, assessment and management) and research suggests autistic people may be more likely to experience depression than non-autistic people (Depression (autism.org.uk). Change in routine can have a big effect on people’s emotional and mental wellbeing. A hospital setting may make people with a learning disability and autistic people more anxious or lead to adverse behaviours, such as hurting other people, hurting themselves or damaging property. Do not assume that this is an indication of mental illness and do your best to work with the person who is unwell, their carer or family member to find out how best to keep them calm and relaxed.

 

For information on prescribing in mental health conditions see our Mental Health Prescribing page and for information on Mental Health services see the Somerset Mental Health and Learning Disabilities Commissioning Team page.

 

Learning from Lives and Deaths – People with a Learning Disability and Autistic People (LeDeR) Programme

The Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR) programme is a national programme that aims to make improvements to the quality of health and social care services for people with learning disabilities and autistic people. Somerset ICB are responsible for co-ordinating this programme and taking forward the actions from learning within Somerset. For more detail about the Somerset programme see Somerset ICB Learning Disabilities and Autism page.

It is important for the ICB to be informed when a person with learning disabilities has died. Anyone can do this including GPs, health and social care staff, family members, friends and carers. Visit the notify us, see how to do this by visiting the NHS LeDeR website and click on the link to report a death.

NHS Somerset: About the LeDeR Programme

We need to talk about death - NHS Somerset ICB